- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,365.00 / $3,100.50 / $5,460.00
| Facility | | $1,365.00 | $3,100.50 | $5,460.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.15 / $1,153.91 / $1,491.75
| Professional | | $930.15 | $1,153.91 | $1,491.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,440.00 / $1,440.00 / $5,185.21
| Professional | | $1,440.00 | $1,440.00 | $5,185.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,340.00 / $4,119.38 / $7,019.45
| Facility | | $2,340.00 | $4,119.38 | $7,019.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,374.96 / $9,399.00 / $9,399.00
| Professional | | $2,374.96 | $9,399.00 | $9,399.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $2,340.00 / $4,387.50
| Facility | | $294.00 | $2,340.00 | $4,387.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,047.50 / $2,554.50 / $4,231.50
| Professional | | $2,047.50 | $2,554.50 | $4,231.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.50 / $1,925.89 / $3,535.92
| Professional | | $1,657.50 | $1,925.89 | $3,535.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $4,119.38 / $7,019.45
| Facility | | $597.00 | $4,119.38 | $7,019.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.75 / $2,106.00 / $4,247.10
| Professional | | $1,140.75 | $2,106.00 | $4,247.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.10 / $1,053.00 / $2,632.50
| Professional | | $737.10 | $1,053.00 | $2,632.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,792.24 / $2,242.44 / $2,242.44
| Facility | | $1,792.24 | $2,242.44 | $2,242.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.50 / $1,950.00 / $2,343.73
| Professional | | $1,657.50 | $1,950.00 | $2,343.73 |